tbuckley/cabot-search huggingface dataset:
Use of positron emission tomography-computed tomography (PET-CT) scan in cancer patients: A single Canadian academic oncology center experience.
Authors: Carlos Enrique Melendez-Pena, Ahmad Gebai, Francine Aubin, Jean-Pierre M. Ayoub, Normand Blais, Danielle Charpentier, Marie Florescu, Bertrand Routy, Mustapha Tehfe
Journal: Journal of Clinical Oncology (2023)

e18691 Background: PET-CT scan is key tool in the diagnosis and follow up of cancer patients. In 2017, a governmental study demonstrated that the use of PET-CT scans in the province of Quebec, Canada was two times more elevated than other Canadian provinces, and similar to the United States (507 vs 510 PET-CT scans per 100,000 persons, respectively). In Quebec, the governmental agency Institut national d’excellence en santé et en services sociaux (INESSS) published recommendations for judicious use of PET-CT scans, derived from evidence-based literature and publications from international oncology societies . We sought to evaluate the use of PET-CT scans in our institution with regards to INESSS guidelines. Methods: A total of 1561 PET-CT scans were performed for oncologic purposes at the CHUM between September 1 st and November 30 th 2019. TEP-CT scans from patients under 18 years of age or who were not followed at our center were excluded. 975 PET-CT scans respected our criteria. We reviewed disease and clinical characteristics of patients, adherence to 2017 INESSS guidelines, imaging indication (staging, response to treatment, or follow up), and type of specialties requesting the exam. Results: Oncologic PET-CT scans were most frequently prescribed by surgeons (39%), followed by oncologists (29%) and radiation-oncologists (12%). 530 (54%) PET-CT scans followed guidelines, 377 (39%) did not, and 68 (7%) were not included in INESSS guidelines. Adherence to guidelines was similar between oncologists and surgeons (54% and 53%, respectively). PET-CT scans ordered by radiation-oncologists followed guidelines in 67% of cases. Lung (29%), breast (19%), and gastro-intestinal cancers (16%) were the sites for which the exam was most requested. Whereas 77% of PET-CT scans requested for lung cancer followed guidelines, only 17% of breast cancer PET-CT scans did. Misuse of this imaging tool was also observed in the investigation of cancer of unknown origin, where only 17% of ordered PET-CT scans followed guidelines. Conclusions: In our institution, 39% of PET-CT scans prescription did not follow guidelines. Variability in adherence to guidelines was significantly more noticeable between primary cancer sites compared to types of specialties requesting the exam. To avoid wasting of resources, we advocate for respecting guidelines and discussing in tumor-boards the off-label use of PET-CT scans. Judicious use of PET-CT scans is particularly important in a public health system for appropriate allocation of resources.
A population-level analysis of survival in patients with ALK+ anaplastic large cell lymphoma (ALCL) in the era of novel therapies.
Authors: Rahul Mishra, Danai Dima, Arda Durmaz, Agrima Mian, Sudipto Mukherjee, Paolo Fabrizio Caimi, Deepa Jagadeesh
Journal: Journal of Clinical Oncology (2023)

e18863 Background: The introduction of novel therapies such as brentuximab vedotin (BV), has changed the treatment paradigm of ALK+ALCL in both upfront and relapsed/refractory settings. We sought to compare differences in the survival trends of patients with ALK+ ALCL in the routine clinical practice, before and after approval of BV (year 2011). Methods: We used SEER-17 registry to identify adult patients using international classification of disease code for oncology assigned to ALK+ ALCL (9714/3) between 2000-2019.We excluded patients (pts) with diagnosis on autopsy or from death certificate, unknown survival time, any other malignancy, cause of death other than non-Hodgkin lymphoma, or survival of &lt; 2 months from diagnosis. Follow-up period was until December 2019. Demographics and treatment details were extracted using SEER Stat v8.4.0.1. Comparisons were made between pts diagnosed in 2000-2010 (pre-BV) vs 2011-2019 (post-BV) using R v4.0. 2. Chi-squared test was used to calculate difference between categorical variables. Kaplan-Meier method and log-rank test were used to estimate overall survival (OS). A multivariate cox proportional hazard (CPH) model, adjusted for sex, radiation, and time-dependent covariates was used to estimate impact of time-period on survival. Results: A total of 1794 pts (n = 956 pre-BV, and 838 post BV) with ALK+ ALCL were identified. The majority were male (1099, 61%), white (78%), and had median age of 49 (IQR: 34-62) years at diagnosis. The baseline characteristics of pts diagnosed during the two time periods were similar (Table). 3-year (y) and 5y OS (95%CI) were 81% (78.1-83.7) and 79% (75.9-81.9) in post-BV vs 61% (58.0-64.2) and 58% (55.5-61.7) during pre-BV period (P &lt; 0.0001, log rank test). Multivariate model showed increased risk of death in the pre-BV vs post-BV period particularly among those surviving &gt; 6 months after diagnosis [log(HR), (95%CI)] = [1.12 (0.86-1.38)]. Conclusions: Using data from nationwide cohort, we demonstrated an improvement in the OS trend of pts with ALK+ ALCL treated in the era of novel targeted therapies, compared to those treated in pre-BV era. [Table: see text]
The impact of extending CRC screening to the older population: Results from CRC-AIM microsimulation model.
Authors: Derek W. Ebner, John B. Kisiel, Chris Estes, Vahab Vahdat, Paul J. Limburg
Journal: Journal of Clinical Oncology (2023)

10567 Background: Average-risk screening for colorectal cancer (CRC) is effective and recommended. The U.S. Preventive Services Task Force issued grade A and B recommendations for screening ages 50-75 and 45-49, respectively, however the recommendation for the older population (ages 76-85) is grade C (moderate certainty that the net benefit is small). With emerging blood-based CRC screening, we evaluated the benefits of screening the older population with continued multi-target stool DNA (mt-sDNA) or FIT strategies and/or with a modality shift to blood-based tests after age 75. Methods: Using the validated CRC-AIM microsimulation model, triennial mt-sDNA and annual FIT screening (ages 45-75) followed by four strategies for ages 76-85 (no screening, continued mt-sDNA/FIT, or a modality shift to blood-based screening using either CMS criteria [CMS] or recently reported blood test data from the ECLIPSE study 1 [BT; Guardant Health, Inc.] were considered. For CMS criteria and BT, CRC sensitivity were set at 74% and 83%; and adenoma sensitivity was set to 20%, and 13%; and CRC specificity was set to 90% for both tests. Real-world (RWE) adherence for initial screening was set to 80% (CMS, BT), 65.6% (mt-sDNA), and 42.6% (FIT). Adherence for follow-up colonoscopy was set to 72.1% (mt-sDNA, CMS, BT) and 46.0% (FIT). Results: Screening among the population aged 45-85 resulted in 281 life years gained (LYG) with continued mt-sDNA as compared to 193 with continued FIT. Furthermore, mt-sDNA reduced CRC mortality by 70% as compared to 49% by FIT (Table). When screening modality was shifted to CMS (76-85 year olds), mt-sDNA/CMS resulted in 279 LYG as compared to 196 for FIT/CMS. CRC incidence was reduced by 59% (mt-sDNA/CMS) as compared to 38% (FIT/CMS), and mortality declined by 69% (mt-sDNA/CMS) as compared to 51% (FIT/CMS). Reductions in disease burden were lower when modality was switched to BT after age 75 due to reduced test performance. Conclusions: Extending CRC screening to the older population with continued mt-sDNA demonstrated the best health outcomes compared to other modalities. A modality shift after age 75 to blood-based testing resulted in greater LYG as compared to no screening, with performance at CMS criteria yielding better results than BT. Therefore, despite inferior performance, blood-based tests may offer a CRC screening option for older patients who are unable to complete stool testing. [Table: see text]
Racial disparities in utilization of first line targeted therapies for metastatic breast cancer.
Authors: Yehoda M. Martei, Kan Chen, Ronac Mamtani, Lawrence N. Shulman, Rebecca A. Hubbard, Amy Sanders Clark
Journal: Journal of Clinical Oncology (2023)

6528 Background: This study evaluated whether there were racial disparities in utilization (decomposed as change in proportion of eligible patients initiating therapy over time and time to treatment initiation (TTI)) to CDK4/6 inhibitors and pertuzumab since FDA approval as first line (1L) treatment for ER+/HER2- and HER2+ metastatic breast cancer (MBC), respectively. Methods: This cohort study used the nationwide Flatiron Health electronic health record-derived de-identified database. Included women were ≥18 years old, diagnosed with de novo or recurrent MBC, who received 1L therapy, and documented as non-Hispanic White (NHW) or non-Hispanic Black/African American (NHB). Two cohorts were generated for patients with ER+/HER2- MBC diagnosed 3/2015-10/2021 and HER2+ MBC diagnosed 7/2012-9/2021. We estimated temporal trends in the proportion of NHW and NHB patients receiving respective therapy using logistic regression with natural cubic splines for time trends and tested for changes in uptake over time within each group as well as differences in trends between groups. A similar model was used for TTI among treatment initiators, using linear regression models. In addition to time and race, regression models included age, ECOG performance status, insurance, Medicaid expansion status, practice type, and proportion of black patients per practice among patients who met both cohort criteria. Results: 8318 patients (NHW=7006; NHB=1312) met ER+/HER2- cohort criteria and 2321 (NHW=1915; NHB=406) met HER2+ cohort criteria. There was a significant change over time in the proportion of NHW (p&lt;0.0001) and NHB (p&lt;0.0001) initiating 1L CDK4/6 inhibitors (Table). Temporal trends were also significantly different between NHW and NHB (p&lt;0.0001). Higher ECOG performance status (OR=0.85 per unit increase, 95%CI 0.80-0.90; p&lt;0.001) and an increasing proportion of black patients seen at practice (OR=0.45, 95%CI 0.29-0.71; p&lt;0.001) were independent predictors of lower odds of initiating CDK4/6 inhibitors. Overall, 43% NHW vs 41% NHB received pertuzumab respectively. There was no significant difference in uptake trends for pertuzumab between NHW and NHB (p=0.41). There was no significant difference in the temporal trends of TTI for either CDK4/6 inhibitors (p=0.74) or pertuzumab (p=0.84). Conclusions: Utilization of CDK4/6 inhibitors steadily increased over time, however &gt; 25% of eligible patients did not receive the drug, and less than half of individuals who met indication for pertuzumab were prescribed it. Racial disparities were significant for oral CDK4/6 inhibitors but not for intravenous pertuzumab. [Table: see text]
Correlation of unobserved incidence of cancer in earlier stages with the observed incidence.
Authors: Jagpreet Chhatwal, Andrew ElHabr, Christopher Tyson, Selin Merdan, Xiting Cao, Sana Raoof, A. Burak Ozbay, A. Mark Fendrick, Paul J. Limburg, Tomasz M. Beer, Ashish Deshmukh
Journal: Journal of Clinical Oncology (2023)

10634 Background: Population-level cancer registries report observed (screening or clinically detected) incident cancer cases. However, the underlying true cancer incidence may be higher than observed. We estimate the unobserved cancer incidence by stage for eight different cancers. Methods: Using the CDC’s National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) combined incidence databases, we first estimated observed incidence rates by cancer type and stage. Newly observed cancers in later stages must have existed at a previous point in time at an earlier stage (and age). Considering that, we used backward induction approach to estimate the unobserved incidence rate of cancer. We also accounted for mortality from competing factors before cancer was detected. Cancer progression between stages was defined by dwell times, which were synthesized in an ensemble approach from published literature and empirical estimates. We estimated unobserved annual incidence cases in early-stage (stages I and II) for the age 50+ population and compared them with observed incidence cases for each cancer type between 2015-2019. Results: The below table shows the annual unobserved and total (unobserved plus observed) cancer incidence by stage for the eight most prevalent cancers. We estimated that the top three cancers with the highest proportion of unobserved early-stage annual incident cases were lung (157,400 cancers unobserved out of 226,400 total), with 70% unobserved; pancreatic (34,700 annual unobserved out of 52,500 total), with 66% unobserved, and non-Hodgkin’s lymphoma (46,400 unobserved out of 73,600 total), with 78% unobserved. In contrast, the cancers with the lowest proportion of unobserved early-stage incident cases were breast (29,100/203,400 [14%]), urinary bladder (27,000/81,800 [33%]), and prostate (110,600/258,900 [43%]). Cancers with a high screening rate have lower unobserved early stage incidence than cancers with a low screening rate or without a screening test. Conclusions: We estimated a large undiagnosed incidence of cancer in early stages. This represents an opportunity for novel early detection technologies to detect cancer in earlier stages. [Table: see text]
The effect of an ultraviolet photography educational exercise on sunscreen application.
Authors: Jade N Young, Dina Poplausky, Shayan Owji, Leore Lavin, Hansen Tai, Benjamin Ungar, Nicholas Gulati, Jonathan Ungar
Journal: Journal of Clinical Oncology (2023)

e22506 Background: Sun exposure is a known risk factor for skin cancer development. Sun protection factor (SPF) is based on an application of 2 mg/cm2 of facial surface area (FSA). Studies demonstrate that most people do not apply a sufficient volume to achieve the intended SPF, thus overestimating their sun protection. Ultraviolet photography (UVP) is easily performed by placing an inexpensive UV filter over a digital camera lens. Chemical and physical sunscreen appear metallic black and blue, respectively, under UV light, thus helping to visualize sunscreen application. We sought to determine if visualizing application with UVP increases the volume of sunscreen applied and to investigate the effect of demographic factors and sunscreen type (physical and chemical) on the results of the intervention. Methods: Participants were recruited from June to August 2022. Subjects were randomized to either physical or chemical sunscreen for the first round of sunscreen application. Using a mirror, subjects applied sunscreen as they normally would. Subjects were then shown a UV photo that helped visualize the extent of sunscreen application. With a clean face, the process was repeated with the other sunscreen type (physical or chemical), such that each subject applied both types by the end of the study (round 2). Sunscreen bottles were weighed before and after applications to calculate the volume of sunscreen applied. Statistics were performed in RStudio version 1.4.1717, a language and environment for statistical computing. Results: 30 subjects (ages 18 to 88, Fitzpatrick skin type I-V) were enrolled. A greater percentage of participants applied &gt; 2mg/cm2 from round 1 to round 2 (23% vs 36%). Mean application volume significantly increased from round 1 to round 2 (1.46 SD = 0.936 to 2.15 SD = 1.91, p = 0.0256). Subjects in the “chemical first” group applied a greater amount in round 2 (p&lt; 0.001), however the same was not true in the “physical first” group. Mean sunscreen applied did not significantly differ between chemical and physical in round 1 (p = 0.187). There were no significant differences observed in sunscreen application across race, gender, skin type, and age. Conclusions: The volume of application increased during round 2, indicating that UVP may be an effective intervention to increase the volume of sunscreen application. Differences between the chemical first and physical first groups indicate the intervention may be more suited to teach the application of chemical sunscreen, which appears darker on UVP. Lack of difference between sunscreen types in round 1 suggests there was negligible pre-intervention bias in application behaviors. Overall, most subjects applied less than the recommended amount of sunscreen in both rounds, suggesting that additional counseling is paramount to ensuring proper sunscreen utilization among the public to prevent skin malignancy.
Association of major adverse financial events and later stage cancer diagnosis in the US.
Authors: Robin Yabroff, Angela Mariotto, Jennifer Stevens, Amy J. Davidoff, Veena Shankaran, Kevin C Ward, Xiao-Cheng Wu, Stephen M. Schwartz, Joan Warren
Journal: Journal of Clinical Oncology (2023)

6545 Background: Studies have documented an increased risk of bankruptcy and other financial hardships for individuals following a cancer diagnosis in the US. Few studies, however, have examined how patients’ financial situation prior to cancer diagnosis is associated with cancer stage at diagnosis. This study assessed the prevalence of the specific major adverse financial events (AFEs) of bankruptcies, liens, and evictions prior to cancer diagnosis and their association with later stage diagnosis. Methods: Individuals aged 21 to 69 years diagnosed with cancer during 2014-2015 were identified from the SEER population-based registries for Seattle, Louisiana and Georgia. Registry data were linked with LexisNexis consumer data to identify patients with a history of court-documented AFEs. All AFEs occurring at any time prior to cancer diagnosis were identified. The association of AFEs and later stage cancer diagnoses (Stages III/IV) was assessed with sex-specific multivariable logistic regression. Results: Among 101,649 individuals diagnosed with cancer linked to LexisNexis data, 36,791 (36.2%) had a major AFE reported prior to diagnosis. The most recent event occurred a mean of 7.8 years prior to diagnosis. For individuals with an AFE, one-third experienced multiple events. Within each registry, AFEs were most common among non-Hispanic Black, unmarried, and low-income individuals. However, even in the highest income group, 27% had a prior AFE. Individuals with prior AFEs were more likely to be diagnosed with later stage cancer than individuals with no prior AFE (males-odds ratio (OR) 1.09; 95% CI, 1.03 to 1.14; P &lt; .001 and females-OR 1.11; 95% CI, 1.06 to 1.17; P &lt; .0001), after adjusting for age, race and ethnicity, marital status, income prior to diagnosis, registry, and type of cancer. The association between a major AFE and later stage diagnosis was observed regardless of when the event occurred relative to cancer diagnosis. Conclusions: In this novel cancer registry, LexisNexis consumer data linkage, we found that one-third of individuals newly diagnosed with cancer had a pre-diagnosis bankruptcy, lien, or eviction. Individuals with these AFEs were more likely to have later stage diagnosis, even after accounting for traditional measures of socioeconomic status, such as income. The prevalence of pre-diagnosis AFEs underscores patient financial vulnerability at the time of their cancer diagnosis, even before experiencing any subsequent financial burden associated with cancer treatment. Our findings are especially timely, with growing efforts by health care providers to screen and address patient social needs as part of oncology care.
Association of cannabis use with real-world time to treatment discontinuation (rwTTD) in patients with advanced cancer initiating immune checkpoint inhibition (ICI).
Authors: Dylan M. Zylla, Greg Knowlton, Grace Gilmore, Pamala A. Pawloski, Talya Salz, Amit Kulkarni, Jordan Cowger, Seth Kuranz
Journal: Journal of Clinical Oncology (2023)

e18846 Background: Studies suggest that the immunomodulatory effect of cannabis may impair responsiveness to ICI in cancer patients. These studies were limited by small sample size in a heterogeneous group. Determining the impact of cannabis on cancer control in patients receiving ICI is critical to informing patients and clinicians. We assessed the relationship of cannabis with cancer treatment outcomes using a large national healthcare claims database linked to retail cannabis purchase data. Methods: Using the Forian Inc database from 2017-2022, we identified adults (age &gt; 18 years) with advanced cancer who had ≥ 90 days of continuous health plan enrollment and received ≥ 1 ICI treatment. Point-of-sale purchase records from 18 state cannabis programs defined cannabis consumers (CC; any purchase prior to first ICI to last known follow-up) and cannabis non-consumers (CNC; no known cannabis purchases). We abstracted data on patient demographics, cancer history, cannabis utilization (dates of purchases, routes, strains), and all cancer-directed therapy claims. rwTTD was calculated from time of first ICI to a defining discontinuation event (change in therapy, gap of &gt; 120 days, or end of enrollment in health plan). Results: From a database of nearly 68 million patients, 20,675 patients met the inclusion criteria (374 CC and 20,301 CNC). Baseline characteristics were similar between the two groups (e.g., age, diagnosis type, time to first ICI) (Table 1). Lung, melanoma and renal cancers account for nearly half of all identified diagnoses. By day 30 after ICI initiation, 45% of CC had made at least one cannabis purchase. Median time from advanced cancer diagnosis to first ICI and median follow up time were also similar (Table 1). The difference in median rwTTD between CC and CNC groups was small relative to the overall variation of this outcome (Table 1) and remained similar (88 days) when restricting analysis to CC with first purchase within 30 days of ICI. Conclusions: Cannabis use does not appear to be associated with rwTTD in advanced cancer patients initiating ICI. Formal statistical testing using inverse probability treatment propensity weighting and adjustment for confounding factors (opioids/glucocorticoids) to assess rwTTD and real-world overall survival is ongoing. Well designed, prospective cohort studies of CC and CNC are needed to minimize selection bias in studies of cannabis use. [Table: see text]